First of all, diet is a correctable risk factor, therefore, patients after coronary artery bypass grafting should pay attention to the diet.
1, pay attention to the supplement of high-quality protein. Ensure 1 egg, 50g of lean meat, 50g of fish and appropriate amount of soy products every day
2.Low-fat diet
Dietary intake of animal fat should be limited, when cooking, more vegetable oil is used, and cholesterol is limited to less than 300 mg per day. Fat-lowering foods are preferred to soybean products. Black fungus has the effect of anti-platelet coagulation, lowering blood lipids and stopping blood cholesterol deposition. Capsicum, oats and barley are good for lowering blood lipids, lowering blood cholesterol and reversing fatty liver. High blood lipids cause patients’ blood to be sticky, form arterial plaques and cause atherosclerosis, so the intake of fat and cholesterol should be strictly controlled. Try not to use fatty meat, animal oil, chocolate and other foods, and use vegetable oil. Eat more fish, which contains unsaturated fatty acids and has the effect of preventing atherosclerosis. In addition, snapper, garlic, kelp, fresh milk and red pepper can lower cholesterol, while animal offal, brain, egg yolk and fish roe should be consumed sparingly, which are high in cholesterol.
3.Vitamins and fiber
Fruits and vegetables are rich in vitamins, potassium, magnesium, these substances can maintain the nutrition of the heart muscle and lipid metabolism, vitamins can reduce the absorption of cholesterol in the intestine, which is conducive to the prevention of coronary heart disease, but also to prevent constipation. The main sources of food fiber are coarse grains, celery, bean sprouts, strawberries, pineapple, rice bran, etc.
4.Low sodium diet
Low sodium diet should eat less salt or smoked food; canned food are to eat less.
5.Other diets should be a small number of meals, avoid overfull, do not drink strong tea, drinks containing coffee
Avoid eating flatulent food such as raw radish and dried beans, so as not to affect the heart activity with intestinal flatulence. In terms of alcohol consumption, a small amount of alcohol can properly increase blood circulation, which is conducive to the smooth flow of bridge vessels, and those who do not drink alcohol before surgery may not need to drink alcohol.
6, avoid eating foods that excite the nervous system
Such as wine, strong tea, coffee, etc. Secondly, rehabilitation exercise after coronary artery bypass grafting is also extremely necessary. Exercise prescription must be made, because coronary artery bypass graft patients have different preoperative symptoms and their respective cardiac function levels are different, so there must be individual guidance for rehabilitation exercise and strengthen their own moderate and appropriate exercise after surgery. Any exercise prescription should be based on disease diagnosis, health status, functional status of cardiovascular and exercise organs, age, gender, exercise history and exercise preferences. The appropriate exercise method and amount of exercise should be selected according to the recovery from coronary artery bypass grafting and the presence of complications.
In conclusion, the rehabilitation exercise prescription should be individualized. Exercise prescription is also called training exercise program. Exercise prescriptions must be developed for post-coronary artery bypass grafting patients and should be carefully tailored, as should medication prescriptions. The exercise prescription includes the type of exercise, intensity, duration, frequency and rate of progression. In addition, home exercise should be reinforced after discharge from the hospital.
Appropriate postoperative exercise is beneficial for bridging the blood vessels, increasing myocardial blood volume, and improving myocardial blood supply and reserve capacity. Appropriate exercise can also reduce patients’ depressive symptoms and maintain a good mood. Patients should choose exercise according to their actual situation, aerobic exercise is appropriate, such as jogging, walking, tai chi, cycling, etc., the time is generally 20-30min, after the activity to increase the heart rate of 10%-20% of the original heart rate is appropriate. After the operation, you should go to the hospital regularly for review, which includes heart sound auscultation, chest X-ray, electrocardiogram and vascular ultrasound. If there are palpitations, syncope and other indications of maladjustment, you should go to the hospital immediately.
1.Type of exercise
The purpose of rehabilitation exercise is to obtain and maintain normal physical activity capacity. Whether this can be achieved depends on several basic factors, which include cardiopulmonary tolerance, structure of the body (fat as a percentage of body weight), muscle strength and endurance, and flexibility of joints. The most important thing for coronary artery bypass graft patients after surgery is to increase cardiopulmonary tolerance. Aerobic endurance activities improve cardiopulmonary tolerance and are divided into two groups.
The first group: physical activity is characterized by little exercise intensity and little change in heart rate, such as walking, jogging, climbing stairs, riding an exercise bike, doing various types of health exercises with various apparatus training, relics playing taijiquan, dancing taiji sword, etc.
The second group: physical activity is characterized by sustained exercise intensity and not easy to maintain physical activity, such as dance, games, ball games and other activities.
2.Exercise intensity
Exercise intensity refers to the amount of exercise within a certain period of time. Improving the endurance of the cardiovascular system requires a certain intensity of exercise. Exercise intensity requires proper monitoring to determine if it is appropriate, and it is the most difficult part of designing an exercise prescription. In medical rehabilitation, exercise intensity can be determined based on metabolic indicators expressed in terms of heart rate, maximum oxygen uptake, and level of self-conscious fatigue. Of these metrics, maximal oxygen uptake is the most difficult to implement. The relationship between heart rate and exercise intensity is linear and proportional. However, coronary artery bypass graft patients have to take medications for quite a long time after surgery, such as calcium antagonists that have an effect on heart rate and do not objectively reflect exercise intensity. We suggest that patients after coronary artery bypass grafting should apply talking exercise level to grasp the intensity of exercise.
Talking exercise level: the exercise intensity that talks while exercising without obvious shortness of breath is the appropriate exercise intensity to produce training. If you can sing during the exercise, it means that the exercise intensity is not large enough.
3.Motion duration
It is the time required for one rehabilitation training. It can be divided into three stages: adaptive activities, cardiorespiratory endurance training and relaxation activities. The time required for each of the three phases is: 5-10 minutes; 20-30 minutes; and 5-10 minutes. Adaptive activities include flexion and extension of joints, slowly increasing the volume of exercise, etc.. It can avoid sudden high-intensity exercise together with myocardial ischemia and prevent muscle and joint injury. For patients with poor health status after coronary artery bypass grafting, the adaptive activity should be extended appropriately. Cardiorespiratory endurance training exercise is high intensity and should not exceed 10-15 minutes for patients who first participate in the exercise. Relaxation exercises are designed to reduce the discomfort after exercise. At the beginning of and during relaxation exercise, the heart rate should return to normal soon. If the heart rate recovers slowly during relaxation exercise, the intensity of exercise should be reduced appropriately according to the situation.
4.Exercise frequency
We recommend intermittent exercise for patients after U-artery bypass surgery at the beginning. Intermittent exercise is alternating exercise and rest, but its accumulated exercise time should not be at least lower than the prescribed continuous exercise time, and the ratio of exercise to rest time is 1:1.
The advantages of intermittent exercise for patients with coronary artery disease are.
1. Patients achieve a higher intensity of exercise with less fatigue because, unlike continuous exercise, the accumulation of lactic acid can be reduced during the rest period.
2. The number of stimuli for cardiac training is higher, mainly because of the ability to repeat the amount of heart beats, venous return and intracardiac pressure. Frequency of exercise refers to the number of rehabilitation exercises per week. In order to achieve the desired effect of rehabilitation exercise, the patient should exercise no less than three times per week, and the time between each exercise should not exceed 2 days. Patients who participate in exercise three times per week can have some degree of improvement in cardiopulmonary tolerance after 2-3 weeks, and there is usually a significant improvement after 6-8 weeks. At the same time, we emphasize that coronary artery bypass graft patients must exercise consistently in order to maintain the exercise effect. If the frequency of exercise is reduced to 1 time per week, half of the acquired cardiorespiratory fitness will be lost within 10 weeks. If the activity is stopped completely, the patient will lose all the acquired cardiorespiratory tolerance within 5 weeks.
3. The rate of progression of the exercise program: The progression of the exercise program depends on the individual’s maximum physical capacity, health status, age and goals. Exercise is prescribed for cardiorespiratory tolerance in three phases, namely the start phase, the improvement phase and the maintenance phase.
Patients can go home and be active if they have no palpitations, shortness of breath, chest pain and angina at rest, no heart failure, heart rate below 110-120 beats/min, no serious arrhythmias, no myocardial ischemic changes on ECG, and ST-segment downshift less than 0.1 mV. In the initial stage, the daily activity should be continued at the later stage of hospitalization, and later on, it can be added to take care of daily life and do general household work, such as sweeping, scrubbing floors, buying vegetables, cooking, washing dishes, etc., and can also participate in some relaxing recreational activities, such as watching TV, etc., but excessive exertion, tension and excitement should be avoided. Six months after heart surgery, patients can resume work and gradually resume their original physical activities. To reduce risk factors and prevent recurrence is the purpose of long-term rehabilitation treatment, and appropriate indoor and outdoor activities can be carried out according to the physical condition.
(1)Walking: pay attention to control the speed, distance and time when walking, the amount of exercise should be small at the beginning and gradually increase, outdoor walking should be accompanied by family members.
(2) playing taijiquan: taijiquan movements stretch natural, rigid and flexible, moving in the quiet, more suitable for coronary heart disease patients rehabilitation exercise, generally choose to simplify taijiquan, the amount of exercise should be small at the beginning, gradually increase the range of action, extend the time.
(3) massage: massage can make the muscles relax, blood circulation accelerated, regulate the function of the central nervous system, relieve mental tension.
(4) Natural therapy: Stable period can go to the forest, high mountains, seaside walking, one is to exercise the limbs, the other is to breathe fresh air, conducive to improving the function of the central nervous system and respiratory system.